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Panic attack
Presentation
You are working in a small rural hospital when a 38 year old woman presents with hyperventilating due to a panic attack. She is visiting friends and has been under considerable stress following a recent marital breakdown and the loss of her job.
The attack began an hour ago when she developed palpitations dizziness, mild chest discomfort and shortness of breath. She reports 3 similar episodes over the past 6 months and has recently been commenced on an antidepressant drug. The other attacks, although similar to the current episode, have been shorter, lasting 10 to 30 minutes. She has leant to control them by holding her breath but this has not been effective on this occasion
She has a past medical history of asthma and takes a salbutamol puffer when required. She is on no other medication.
On examination she appears anxious and is hyperventilating with a respiratory rate of 45 / minute. Her chest is clear and her saturations are 99% (on room air). She is tachycardic and her blood pressure is 110/70.
An ECG is performed
Assessing the ECG
When examining an ECG to determine the rhythm it is useful to first describe the rhythm before attempting a spot diagnosis. This approach is especially helpful where the cause for the arrhythmia is not immediately obvious and narrows down the diagnostic possibilities. In addition even where the diagnosis appears "obvious" it is important to consider the differential diagnosis as on occasions the obvious diagnosis is incorrect.
When describing a rhythm there are four characteristics that are used.
Rate - fast > 100 min, slow < 60 / min
Regularity - regular, irregular
Width of the QRS - < 0.10 secs, > 0.10 secs
Normal p wave - present, absent
Commonly encountered dysrhythmias can be readily classified using this approach and it provides a useful framework for the assessment and management of dysrhythmias.
Question
Which one of the following describes the above ECG ?
Wide complex, regular tachycardia. Absent p waves
Narrow complex, irregular tachycardia. Absent p waves
Narrow complex, regular tachycardia. P waves present
Wide complex, irregular tachycardia. P waves present
Narrow complex, regular tachycardia. P waves absent
(Click on the button to select correct answer and proceed to the next page)